Post-allogeneic transplant interventions in ALL

David Marks, MBBS, PhD, FRACP, FRCPath, University Hospitals Bristol NHS Foundation Trust, Bristol, UK, discusses post-allogeneic stem cell transplantation interventions to prevent and treat relapse in patients with acute lymphoblastic leukemia (ALL), including withdrawal of immunosuppression, donor lymphocyte infusions, CAR T-cell therapy, and second transplant. Firstly, Prof. Marks describes the withdrawal of immunosuppression in the hope of enhancing a graft-versus leukemia effect. However, evidence indicates that this is not an effective strategy since it does not result in durable disease control. Another possible strategy is donor lymphocyte infusions (DLI). In the UKALL14 trial, results showed that around half of the patients responded to DLI, but long-term control was disappointing. Additionally, Prof. Marks explains the therapy of choice for post-transplant relapse, CAR T-cell therapy, which is currently only approved for the treatment of children and young adults up to the age of 25 years. The last therapeutic option discussed for patients relapsing after allogeneic transplant is a second transplant, though there is limited data in patients with ALL. This interview took place during the 2021 European School of Hematology (ESH) 2nd Translational Research Conference on Acute Lymphoblastic Leukemia.